Advancements in the Treatment of Necrotizing Otitis Externa with Hyperbaric Oxygen: A Systematic Review.

Introduction: Necrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe infection that begins in the external auditory canal and can extend to adjacent tissues and bone. It primarily affects elderly, diabetic, and immuno-compromised patients. Despite the advancements in antibiotics and surgical interventions, NOE remains a condition with significant morbidity and mortality.

Objective: To evaluate the efficacy of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment for NOE, focusing on clinical outcomes and the potential benefits in refractory or advanced cases.

Methods: We conducted a comprehensive literature search on the PubMed/MEDLINE and Cochrane Library databases for articles published from January 1980 to December 2023. The search terms included hyperbaric oxygen therapy , necrotizing otitis externa , and refractory otitis . A total of 8 studies met the inclusion criteria, comprising case reports, observational studies, and case series. Study quality was assessed through the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale.

Results: The results indicate that HBOT shows promise in the treatment of NOE, with several studies reporting complete resolution of infection and prevention of recurrence, especially in refractory cases.

Conclusion: The current evidence is insufficient to establish HBOT as a standard treatment for NOE; however, its potential benefits in improving clinical outcomes and reducing morbidity are significant. High-quality research, including randomized controlled trials, is necessary to validate the role of HBOT in NOE treatment. Where hyperbaric facilities are accessible, HBOT should be considered for refractory NOE cases.